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Alzheimer's Disease and other Dementias

Preventing Apathy in Dementia Patients

Nursing home residents with dementia are less likely to be apathetic if they live in an appropriately stimulating environment, according to a multi-university study published in June 2015 in The Gerontologist. A release from Penn State notes that clear stimulus is found in an environment without competing background noise, and with a single straightforward stimulus. A good example of this is a therapist leading a music therapy program for residents in an otherwise quiet room.

According to a 2013 report by the Centers for Disease Control, nearly half of all residents in nursing homes have dementia. Apathy is one of the most common neurobehavioral symptoms in dementia, with about 90 percent of older adults with dementia experiencing it. Those with mild dementia will decline more quickly into severe dementia if they also suffer from apathy, so helping them stay engaged is important.

The release quotes Ying-Ling Jao, assistant professor of nursing at Penn State, as saying, “Persons with dementia who are also apathetic won’t be curious about the world around them; they are not motivated to carry out activity nor engage with those around them, in either a positive or a negative way. Apathy has several negative consequences for both the persons with dementia and their caregivers. The individuals’ cognitive function will likely decline faster and their caregivers will have more difficulty with their caregiving and are more likely to become depressed.”

Jao observed 40 nursing home residents with dementia by watching video recordings of each taken throughout a typical day. She chose three videos per resident from recordings made during a previous study — one taken at a mealtime, one during a direct interaction between the resident and staff, and one that was randomly selected.

“The purpose of this study was to examine the relationship between environmental characteristics and apathy in long-term care residents with dementia,” said Jao. “My interest in apathy was mainly driven by my clinical observations in nursing homes when I was a nurse practitioner student. I remember that no matter which nursing home I visited, I often saw a crowd of residents sitting in the living room or hallway with no interest in the surroundings and no emotional expression.”

Jao looked at five characteristics in particular: environmental stimulation, ambiance, crowding, staff familiarity, and light and sounds. Of the five, clear and strong environmental stimulation was the most significantly associated with a lower apathy level in the residents.

“Interestingly, our results showed that clear and strong environmental stimulation is related to lower apathy, while no stimulation or an overwhelming environment with no single clear stimulation is related to higher apathy,” the researchers said.